Guest guest Posted November 21, 2004 Report Share Posted November 21, 2004 I have found the insurance part of it to be an absolute nightmare. The problem is that neither dental insurance nor medical insurance want to claim jaw problems as their problem, so they usually end up not being covered (unless it is the result of an accident or birth defect). I know several people who have not had TMJ treatment done because after a long battle, it just wasn't covered. My insurance company would not approve my braces at all (but said they would have been partially covered if I were under 23) and have said that everything must be approved ahead of time (but so far nothing has been approved). I had my wisdom teeth taken out in April and even that the insurance comapany said was not medically necessary (?!?!) and would not reimburse me for. Also, I think it is too important a process to go to an oral surgeon besides the one your orthodontist wants to work with, even if they are not in your network (another problem I've run into). As much as its probably not at all what you want to hear, I would not count on getting insurance coverage unless you have an exceptional plan. I think you need to decide if its something you'll do with or without the insurance coverage, how much its worth it to you. For me it was a long, frustrating process and I finally decided the result would be worth the financial burden. So I am going ahead with everything and hoping it will be reiumbursed later (under the assumption that it will probably not be). The best thing you can do is what you're doing, just try to get authorizations ahead of time. I'm sorry this isn't more positive, and hopefully other people have had other, more hopeful stories to share with you. Good luck! > > Does anyone who has had to battle the insurance company have any > recommendations for someone who is just getting started? I really > wanted to get insurance approval before I got my braces on but they > won't approve that far in advance. I have been reading and it seems > like the battle with them can sometimes take years. Does that mean > you wear the braces for years? The orthodontist I saw told me that > my teeth were already basically straight (except one crooked bottom > tooth) and that he does not recommend braces unless I will be doing > surgery. He says it will actually make my bite more noticeable. My > fear is that I go ahead with braces and then I can't get insurance > approval so I end up with a worse bite than now. I don't think I > could afford the surgery w/out insurance help. > > Is there anything I can start doing, or should be doing, to help with > the insurance process??? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2004 Report Share Posted November 21, 2004 I have found the insurance part of it to be an absolute nightmare. The problem is that neither dental insurance nor medical insurance want to claim jaw problems as their problem, so they usually end up not being covered (unless it is the result of an accident or birth defect). I know several people who have not had TMJ treatment done because after a long battle, it just wasn't covered. My insurance company would not approve my braces at all (but said they would have been partially covered if I were under 23) and have said that everything must be approved ahead of time (but so far nothing has been approved). I had my wisdom teeth taken out in April and even that the insurance comapany said was not medically necessary (?!?!) and would not reimburse me for. Also, I think it is too important a process to go to an oral surgeon besides the one your orthodontist wants to work with, even if they are not in your network (another problem I've run into). As much as its probably not at all what you want to hear, I would not count on getting insurance coverage unless you have an exceptional plan. I think you need to decide if its something you'll do with or without the insurance coverage, how much its worth it to you. For me it was a long, frustrating process and I finally decided the result would be worth the financial burden. So I am going ahead with everything and hoping it will be reiumbursed later (under the assumption that it will probably not be). The best thing you can do is what you're doing, just try to get authorizations ahead of time. I'm sorry this isn't more positive, and hopefully other people have had other, more hopeful stories to share with you. Good luck! > > Does anyone who has had to battle the insurance company have any > recommendations for someone who is just getting started? I really > wanted to get insurance approval before I got my braces on but they > won't approve that far in advance. I have been reading and it seems > like the battle with them can sometimes take years. Does that mean > you wear the braces for years? The orthodontist I saw told me that > my teeth were already basically straight (except one crooked bottom > tooth) and that he does not recommend braces unless I will be doing > surgery. He says it will actually make my bite more noticeable. My > fear is that I go ahead with braces and then I can't get insurance > approval so I end up with a worse bite than now. I don't think I > could afford the surgery w/out insurance help. > > Is there anything I can start doing, or should be doing, to help with > the insurance process??? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2004 Report Share Posted November 21, 2004 But aha! you have stated exactly the grounds upon which many MEDICAL policies cover the surgery: " unless it is the result of an accident or birth defect. " The structural problem is the result of a congenital, structural defect: i.e., one jaw is bigger than the other, or one is smaller. In my case, congenital mandibular hypoplasia. You also can request -- well, no. I should say that under my policy, I COULD request, review by a panel of oral and maxillofacial surgeons. These are the guys and gals who are trained to understand such things. My DENTAL policy paid a lifetime fee of $1,000 or so for ortho. No other relief on that one. Good wishes to you, Cammie > > I have found the insurance part of it to be an absolute nightmare. > The problem is that neither dental insurance nor medical insurance > want to claim jaw problems as their problem, so they usually end up > not being covered (unless it is the result of an accident or birth > defect). I know several people who have not had TMJ treatment done > because after a long battle, it just wasn't covered. My insurance > company would not approve my braces at all (but said they would have > been partially covered if I were under 23) and have said that > everything must be approved ahead of time (but so far nothing has > been approved). I had my wisdom teeth taken out in April and even > that the insurance comapany said was not medically necessary (?!?!) > and would not reimburse me for. Also, I think it is too important a > process to go to an oral surgeon besides the one your orthodontist > wants to work with, even if they are not in your network (another > problem I've run into). As much as its probably not at all what you > want to hear, I would not count on getting insurance coverage unless > you have an exceptional plan. I think you need to decide if its > something you'll do with or without the insurance coverage, how much > its worth it to you. For me it was a long, frustrating process and I > finally decided the result would be worth the financial burden. So I > am going ahead with everything and hoping it will be reiumbursed > later (under the assumption that it will probably not be). The best > thing you can do is what you're doing, just try to get > authorizations ahead of time. I'm sorry this isn't more positive, > and hopefully other people have had other, more hopeful stories to > share with you. Good luck! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2004 Report Share Posted November 21, 2004 But aha! you have stated exactly the grounds upon which many MEDICAL policies cover the surgery: " unless it is the result of an accident or birth defect. " The structural problem is the result of a congenital, structural defect: i.e., one jaw is bigger than the other, or one is smaller. In my case, congenital mandibular hypoplasia. You also can request -- well, no. I should say that under my policy, I COULD request, review by a panel of oral and maxillofacial surgeons. These are the guys and gals who are trained to understand such things. My DENTAL policy paid a lifetime fee of $1,000 or so for ortho. No other relief on that one. Good wishes to you, Cammie > > I have found the insurance part of it to be an absolute nightmare. > The problem is that neither dental insurance nor medical insurance > want to claim jaw problems as their problem, so they usually end up > not being covered (unless it is the result of an accident or birth > defect). I know several people who have not had TMJ treatment done > because after a long battle, it just wasn't covered. My insurance > company would not approve my braces at all (but said they would have > been partially covered if I were under 23) and have said that > everything must be approved ahead of time (but so far nothing has > been approved). I had my wisdom teeth taken out in April and even > that the insurance comapany said was not medically necessary (?!?!) > and would not reimburse me for. Also, I think it is too important a > process to go to an oral surgeon besides the one your orthodontist > wants to work with, even if they are not in your network (another > problem I've run into). As much as its probably not at all what you > want to hear, I would not count on getting insurance coverage unless > you have an exceptional plan. I think you need to decide if its > something you'll do with or without the insurance coverage, how much > its worth it to you. For me it was a long, frustrating process and I > finally decided the result would be worth the financial burden. So I > am going ahead with everything and hoping it will be reiumbursed > later (under the assumption that it will probably not be). The best > thing you can do is what you're doing, just try to get > authorizations ahead of time. I'm sorry this isn't more positive, > and hopefully other people have had other, more hopeful stories to > share with you. Good luck! Quote Link to comment Share on other sites More sharing options...
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